A Biopsychosocial Understanding of Lower Back Pain: Content Analysis of Online Information

N. Black, R. Mani*, J. Sullivan
Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin


Introduction: Lower back pain (LBP) is a leading global burden, causing the most global disability of any condition. Education is a critical aspect to LBP management, therefore, it seems reasonable to suggest that increased access to health information could aid in the management of such a burden. An understanding of current online LBP information and how its content compares to a current understanding of LBP is critical if the internet is to become an effective educational resource in LBP management.

Aims: To analyse publicly accessed online lower back pain information from a Google search for (1) the degree that psychosocial contributors are described alongside the traditional biomedical approach to explaining LBP; (2) whether websites use information on pain biology to educate on LBP; (3) any inaccurate or false information regarding the mechanisms of LBP. 

Methods: An online search was conducted using the Google search engines of six major English speaking countries. Website content was analysed using three checklists developed for the purpose of this study - Biopsychosocial information categorisation checklist and scoring criteria; pain biology information checklist; and the inaccurate information checklist. 

Results: Of the fifteen websites analysed, the content of 26.7% of websites was classified as ‘biomedical’, 60% ‘limited psychosocial’ and 13.3% ‘reasonable psychosocial’; 20% included information on pain biology; 46.7% inaccurately implied pain to be equal to tissue damage and 46.7% implied pathways specific to pain transmission. 

Conclusions: Online LBP information retrieved through a Google search has limited to no integration of psychosocial or pain biology information. The focus on tissue pathology is further supported by the inaccurate descriptions of pain as equal to tissue damage and as an input to the central nervous system. Online LBP information needs to be guided by benchmark criteria more sensitive to the psychosocial contributors to pain.

Acknowledgements: The authors would like to thank Dr Hopin Lee of Neuroscience Research Australia, Sydney, NSW, Australia for his expert advice in developing the analysis tools for the study.



1. Hendrick PA, Ahmed OH, Bankier SS, et al. Acute low back pain information online: an evaluation of quality, content accuracy and readability of related websites. Man Ther 2012;17(4):318–24.

2.  Lee H, McAuley JH, Hübscher M, et al. Does changing pain-related knowledge reduce pain and improve function through changes in catastrophizing? Pain 2016;157(4):922-30.